Sunday, December 03, 2006

(HealthDay News) -- There are clear medical benefits for prescribing cholesterol-reducing statin drugs for people who don't have cardiovascular disease but are at moderate risk of heart attack, stroke or other events, new research indicates.

An analysis of studies that included more than 48,000 people supports current guidelines about who should get statins, said study lead author Dr. Niteesh K. Choudhry, an associate physician at Brigham and Women's Hospital, in Boston.

Those guidelines state that "those at highest risk even without known cardiovascular disease should get statins," Choudhry said. "They suggest that people at moderate risk, they may also benefit."

There are clear benefits for people at moderate risk due to such conditions as diabetes or high blood pressure, in addition to high blood cholesterol, the analysis found. The incidence of major cardiovascular events such as heart attack was 29 percent lower for those who took a statin rather than a placebo, an inactive substance, and a 14 percent reduction in strokes over an average of 4.3 years.

Statin therapy did not reduce the death rate in the trials, "likely because of the relatively low risk of mortality in this patient population and insufficient length of follow-up," the report said.The study was published in the Nov. 27 issue of the Archives of Internal Medicine.

The cost of statin treatment must also be considered against the benefits, Choudhry said. If the 23 million Americans at moderate risk of cardiovascular disease were treated for 4.3 years, an estimated 85,800 strokes and 383,000 major coronary events would be prevented -- but the cost would be at least $40 billion.

"Whether those at moderate risk should be getting statins is a matter of cost-benefit analysis, whether the bang for the buck is worth it," he said.

Dr. Christopher P. Cannon, a cardiologist at Brigham and Women's who was not involved with the study, has no doubts that the benefits of statin therapy outweigh the costs.

"The study is very important news for tens of millions of people here in the United States," Cannon said. "It provides very important evidence supporting the use of statins to lower cholesterol in people at moderate risk."

The study shows that a person would have to be treated with a statin for 4.3 years to prevent one major coronary event, Cannon noted. "That cost is well within the realm of standard medical practice," he said.

Alternative cholesterol-lowering measures, such as better diet, do not offer the same clear benefits as statin treatment, Cannon said. "People take a look at the box of oatmeal in the morning and say, 'Not today,' " he said.

And the price of statin therapy is coming down, Cannon said. "Fortunately, statins are available as generics," he said. "That dramatically reduces the cost of implementing the strategy. Three statins are now available generically."

The analysis also showed statistically significant benefits of statin therapy even for people at relatively low risk, Choudhry added. "But the amount of benefit is small," he said. "The question is, is it worth it?"

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